0001415889-19-001011.txt : 20190911 0001415889-19-001011.hdr.sgml : 20190911 20190911174618 ACCESSION NUMBER: 0001415889-19-001011 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190909 FILED AS OF DATE: 20190911 DATE AS OF CHANGE: 20190911 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Giles Richard B CENTRAL INDEX KEY: 0001525268 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35182 FILM NUMBER: 191089131 MAIL ADDRESS: STREET 1: 5445 DTC PARKWAY STREET 2: SUITE 925 CITY: GREENWOOD VILLAGE STATE: CO ZIP: 80111 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Ampio Pharmaceuticals, Inc. CENTRAL INDEX KEY: 0001411906 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 260179592 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 373 INVERNESS PARKWAY STREET 2: SUITE 200 CITY: ENGLEWOOD STATE: CO ZIP: 80112 BUSINESS PHONE: 720-437-6500 MAIL ADDRESS: STREET 1: 373 INVERNESS PARKWAY STREET 2: SUITE 200 CITY: ENGLEWOOD STATE: CO ZIP: 80112 FORMER COMPANY: FORMER CONFORMED NAME: Chay Enterprises, Inc. DATE OF NAME CHANGE: 20070910 4 1 form4-09112019_020905.xml X0306 4 2019-09-09 0001411906 Ampio Pharmaceuticals, Inc. AMPE 0001525268 Giles Richard B C/O AMPIO PHARMACEUTICALS, INC. 373 INVERNESS PARKWAY, SUITE 200 ENGLEWOOD CO 80112 true false false false Stock Option (Right to Buy) 2.50 2011-03-31 4 D 0 150000 0 D 2021-03-31 Common Stock 150000 0 D Stock Option (Right to Buy) 2.76 2012-05-07 4 D 0 100000 0 D 2022-05-07 Common Stock 100000 0 D Stock Option (Right to Buy) 3.95 2013-03-07 4 D 0 80000 0 D 2023-03-07 Common Stock 80000 0 D Stock Option (Right to Buy) 6.96 2014-06-08 4 D 0 70000 0 D 2024-06-08 Common Stock 70000 0 D Stock Option (Right to Buy) 3.33 2015-12-12 4 D 0 30000 0 D 2025-12-12 Common Stock 30000 0 D Stock Option (Right to Buy) 0.75 2019-09-09 4 A 0 365500 0 A 2029-09-09 Common Stock 365500 0 D This option was cancelled by mutual agreement between the company and the reporting person. This option was cancelled by mutual agreement between the company and the reporting person. This option was cancelled by mutual agreement between the company and the reporting person. This option was cancelled by mutual agreement between the company and the reporting person. This option was cancelled by mutual agreement between the company and the reporting person. 100% of the stock options award vests and becomes exercisable on the date of the grant date. /s/ Richard Giles 2019-09-11